Multiple long-term conditions

Ten years on from the Marmot Review

25 February 2020
4 min read

Over the past decade, very little has progressed at a national scale to reduce inequality. Programme Director Barbara Reichwein reflects on the health inequalities that persist ten years on from the Marmot Review.

In November 2008 Professor Sir Michael Marmot led a review exposing the stark health inequalities in England at the time.

The Fair Society Healthy Lives report demonstrated that health was strongly correlated with social and economic status. The lower this status was, the poorer a person’s health was likely to be.

Marking its anniversary, Health Equity in England: The Marmot Review 10 Years On shows how little has progressed on reducing inequality. It also gives an even stronger impetus to persist with work that shows how the upstream drivers of health inequality can be tackled.

We are identifying ways to do this, taking a long-term view on particularly complex urban health issues.


Listening to people

In our place, people develop their first long-term condition in their early thirties. And, followed by their second in their mid-forties. When the cards are stacked against you in many ways, the chances are you will spend more years in ill-health.

The first thing to do in learning how to address this is to listen to people. Our report with the Taskforce on Multiple Conditions, “Just one thing after another”: Living with multiple conditions demonstrates that ways to protect the health of people with long-term conditions are often hidden in plain sight. Simple changes can be found in people’s homes, money, work and neighbourhoods.

People from our place in south London are currently teaching us about the relationship between their money and health. And second, about the key moments that impact their journey into, and out of, ill-health.


Broadening our circle of partners

We have the privilege of working with partner organisations as diverse as the people within our boroughs. We have learnt that there are too few organisations that work to tackle wider determinants of health. We are actively broadening that circle.

We support community organisations, GPs and CEOs to contribute to healthy environments. To improve health, there isn’t a sector we don’t engage with, and we hope more partners will join us to think outside the box.

For example, we are convening employers in inner-city London to reflect on their role in promoting the health of their employees. And, how responsible supply chains and meaningful, flexible local jobs to the needs of people can improve health.

Health inequalities are not inevitable. The quest to shrink the unknowns in social determinants is a worthy one and we are only just getting started.

Barbara Reichwein
Barbara Reichwein Programme Director

Focusing on our place

We are setting up Neighbourhood Schemes as a key element of our multiple long-term conditions programme. We work at a small geographic scale with places of 10,000 to 30,000 residents to gain a deeper understanding of how we can support good health. These schemes focus on driving change by testing whole-system solutions to health challenges facing the local communities.

One of the first projects to emerge from the Walworth Neighbourhood Scheme has been a new physical place to test a blended model of ‘meaningful connections’. It aims to support people at risk of rapid progression to multiple long-term conditions through clinical and non-clinical approaches.

When the doors of the new Walworth Living Room opened, our partners at Pembroke House, a Southwark-based settlement and social action organisation, began organising a space around people and health. It hosted colleagues from integrated health and social care provision, strengthening the local community’s networks. Together, we are now inviting other partners into the same neighbourhood to combine forces.

Similarly, we are testing a model of social prescribing that is preventative. It is targeting working-age adults at risk of progression, specifically addressing inequalities. We also see potential in supporting self-management through Wakey. It is a new breakfast show delivered on mobile phones to entertain and offer evidence-based mental health support. Ultimately, we see a kaleidoscope of ways emerging to tweak a place to be healthier for us.

In sum, we take courage from Marmot, because health inequalities are not inevitable. The quest to shrink the unknowns in social determinants is a worthy one and we are only just getting started.

We will share what we learn along the way. People, partners and places will be our compass in reducing inequalities in one of the most vibrant, diverse and urban places in the world. We hope you will learn with us and are confident you’ll discover many parallels to other places.

To keep up to date with our work on addressing the social determinants of health, sign up for our newsletter.